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Highlights: 2016 Drug-Susceptible TB Treatment Guidelines										Related Pages
										This document contains key highlights from the Official American Thoracic Society (ATS)/Centers for Disease Control and Prevention (CDC)/Infectious Diseases Society of America (IDSA) Clinical Practice Guidelines: Treatment of Drug-Susceptible Tuberculosis. The guidelines update previous ATS/CDC/ISDA guidelines published in Morbidity and Mortality Weekly Report in 2003.
**About the Guidelines**
The guidelines provide recommendations on the clinical and public health management of tuberculosis (TB) in children and adults in well-resourced settings.
The guidelines provide evidence-based recommendations that have been developed using GRADE (Grading of Recommendations Assessment, Development, and Evaluation) methodology. GRADE involves structured literature review, systematic reviews and meta-analyses of combined data, and expert discussion to assess the certainty in the evidence and determine the strength of each recommendation.**Objectives of Antituberculosis Therapy**
The treatment of TB is centered on curing the individual patient and decreasing the transmission of TB bacteria to other people.
The objectives of TB therapy are:
Cure the individual patient and minimize risk of death and disability;
Reduce transmission of *M. tuberculosis* to other persons; and
Prevent the development of drug resistance during therapy.**Key Considerations When Developing a Case Management Plan**
Use case management interventions during treatment of patients with TB disease. Case management is defined as patient education and counseling, field and home visits, integration and coordination of care with specialists and medical home care, patient reminders, and incentives and enablers. (Recommendation 1)
Use directly observed therapy (DOT) for treatment of patients with all forms of TB disease. (Recommendation 2)**Recommended Treatment Regimens**
The preferred regimen for treating adults with TB remains a regimen consisting of an intensive phase of 2 months of isoniazid (INH), rifampin (RIF), pyrazinamide (PZA), and ethambutol (EMB) followed by a continuation phase of 4 months of INH and RIF. (See table 2 for more information on drug regimens.)
Use the following practices for treatment of drug-susceptible pulmonary TB during the **intensive** phase (Recommendation 3):
Daily dosing, rather than intermittent dosing, is preferred.
If intermittent therapy is needed, use treatment three times per week for patients with:
Low risk of relapse (i.e. drug-susceptible TB organisms, that at the start of treatment is non-cavitary and/or smear negative) and
Negative HIV-infection test result (not HIV-infected).
If it is difficult to treat daily or three times per week, the use of treatment two times per week after an initial two weeks of daily therapy may be considered for patients with:
Low risk of relapse (i.e. drug-susceptible TB organisms, that at the start of treatment is non-cavitary and/or smear negative) and
Negative HIV-infection test result (not HIV-infected).
Use the following practices for treatment of drug-susceptible pulmonary TB during the **continuation** phase (Recommendation 4):
Daily dosing or treatment three times per week is recommended.
If intermittent therapy is needed, treatment three times per week is preferred.
Avoid generally the once weekly regimen of INH 900/RPT 600.
This regimen may be considered in uncommon situations where more than once weekly DOT is difficult to achieve.
When employed, the once weekly INH 900 mg plus RPT 600 mg regimen should be used only in HIV uninfected patients without cavitation on chest radiography and who are smear negative at 8 weeks.**Treatment in Special Situations**
The current guidelines provide recommendations on the management of TB in other special situations as well, such as extrapulmonary TB, culture-negative pulmonary TB, and TB during pregnancy and breastfeeding, among others.
A key highlight in the current guidelines are the recommendations on the duration of the timing of HIV and TB therapy for patients living with HIV.
Patients co-infected with HIV who receive antiretroviral therapy (ART) should receive the following TB treatment regimen (Recommendation 5):
6 month daily regimen for drug susceptible pulmonary TB
Intensive Phase: 2 months of INH, RIF, PZA and EMB
Continuation Phase: 4 months INH and RIF
ART should be initiated during TB treatment (Recommendation 6):
Ideally, ART should be initiated within the first two weeks of TB treatment with CD4 cell counts <50/mm3and by 8-12 weeks of TB treatment for patients with CD4 cell counts > 50/mm; however patients with TB meningitis **SHOULD NOT** start ART before 8-10 weeks of TB treatment is completed, regardless of CD4 count.
Four month treatment regimen is adequate for the treatment of adult patients who are not infected with HIV and who have AFB smear- and culture-negative pulmonary TB (Recommendation 9).
Recommendations for the treatment of patients with TB meningitis and TB pericarditis are also provided in the guidelines.
Initial adjunctive corticosteroid therapy with dexamethasone should be given for six weeks for patients with TB meningitis (Recommendation 8).
Initial adjunctive corticosteroid therapy should not be routinely used in but should be reserved for selected patients with TB pericarditis (Recommendation 7).
							
					
						Page last reviewed:  August 11, 2016					Content source: 	Division of Tuberculosis Elimination, National Center for HIV, Viral Hepatitis, STD, and TB Prevention, Centers for Disease Control and Prevention homeTuberculosisBasic TB Factsplus iconHow TB SpreadsLatent TB Infection and TB DiseaseSigns & SymptomsTB Risk FactorsExposure to TBTB PreventionVaccinesTB & HIV CoinfectionTB and DiabetesTB TermsPersonal StoriesTesting & Diagnosisplus iconWho Should be TestedTesting for TB InfectionTesting in BCG-Vaccinated PersonsTB Screening and Testing of Health Care PersonnelTesting During PregnancyDiagnosing latent TB infection and TB diseaseTreatmentplus iconDeciding When to Treat Latent TB InfectionTreatment Regimens for Latent TB Infection (LTBI)Treatment for TB DiseaseAdverse EventsTB Treatment of Persons Living with HIVTB Treatment and PregnancyTB Treatment for ChildrenFrequently Asked QuestionsDrug-Resistant TBResearchplus iconTB Epidemiologic Studies Consortiumplus iconResearch ProjectsPublicationsTB Trials Consortiumplus iconStudy DescriptionsBackgroundBehavioral & Social Science ResearchHealth Care Settingsplus iconTB Infection Control in Health Care SettingsResources for TB Screening and Testing of Health Care Personnelplus iconFrequently Asked QuestionsTB in Specific Populationsplus iconHealth DisparitiesAsian PersonsBlack or African American PersonsHispanic or Latino PersonsChildrenPregnancyCorrectional FacilitiesPeople Experiencing HomelessnessInternational TravelersLaboratory Informationplus iconDrug Susceptibility TestingFalse-Positive Investigation ToolkitInterim Laboratory Biosafety Guidance for XDR  tuberculosis strainsModel Performance Evaluation Program (MPEP)Rapid Molecular Testing to Detect Drug-Resistant TB in the USplus iconExecutive SummaryIntroductionBackground on Tests for Molecular Detection of DRGeneral Considerations and Principles for a Molecular DR Testing ServicePossible Scenarios and Scope of Testing for a Molecular DR Testing ServiceResearch NeedsGeneral Recommendations of the Expert PanelCommunication Plan for the ReportRecommendationsReferencesPanel Members and CDC ParticipantsAppendix 1Appendix 2Appendix 3The Uses of Nucleic Acid Amplification Tests for the Diagnosis of TBplus iconGeneral ConsiderationsGeneral Recommendations of the Expert PanelRecommendations to ACET, CDC, DTBEData & Statisticsplus iconTB Incidence in the United StatesReported TB in the US, 2022 Surveillance Reportplus iconNational DataReporting Area DataRisk FactorsDemographicsTB Treatment and Case OutcomesDrug-Resistant TBMolecular SurveillanceTuberculosis in the United States, 2022 (Slide Set)Archived Surveillance Reports and Slide Sets2021 State and City ReportArchived State and City ReportsProfessional Resources & Toolsplus iconTools for Healthcare ProvidersResources for TB Programsplus iconStrengthening Civil Surgeons’ Capacity to Improve LTBI Surveillance and Outcomes Among Status AdjustersNotice of Funding Opportunity (NOFO)Program EvaluationTB Centers of ExcellenceTB Elimination AllianceTB Genotypingplus iconConventional TB GenotypingWhole Genome SequencingTB GIMSAnalytic ToolsLatent Tuberculosis Infection ResourcesPublications & Productsplus iconPatient and Public MaterialsFact SheetsGuidelinesplus iconControl & EliminationDrug-Resistant TBInfection Control & PreventionLaboratory & GenotypingTB & HIVTB in Specific PopulationsTesting & DiagnosisTreatmentVaccines & ImmunizationsArchived TB GuidelinesGuides & Toolkitsplus iconAggregate ReportsCDC TB Surveillance TrainingCore CurriculumEffective TB Interviewing for Contact InvestigationEthnographic GuidesFalse-Positive Investigation ToolkitForging Partnerships to Eliminate TuberculosisGuide to Application of GenotypingLTBI: A Guide for Primary Health Care ProvidersMantoux Tuberculin Skin Testing ProductsReport of Verified Case of Tuberculosis (RVCT)Self-Study ModulesTB Contact Investigation Interviewing Skills CourseTB eDOT ToolkitUnderstanding the TB Cohort Review ProcessNewslettersplus iconTB Notes, No. 4, 2023TB Notes, No. 3, 2023TB Notes. No. 2, 2023TB Notes. No. 1, 2023TB Notes, No. 4, 2022TB Notes, No. 3, 2022TB Notes, No. 2, 2022TB Notes, No. 1, 2022TB Notes, No. 4, 2021TB Notes, No. 3, 2021TB Notes, No. 2, 2021TB Notes, No. 1, 2021Pamphlets, Brochures, Bookletsplus iconQuestions and AnswersPatient Education SeriesTuberculosis - Get the FactsTuberculosis - The Connection between TB and HIV12-Dose Regimen for Latent TB Infection-Patient Education BrochurePostersplus iconMantoux Tuberculin Skin Test Wall ChartWorld TB DayThink TBStop TBTake on TBReports & Articlesplus iconDTBE Authored Journal ArticlesTuberculosis Laboratory Aggregate ReportsSlide Setsplus iconIntroduction to TuberculosisEpidemiology of Tuberculosis Among Non-U.S.​–Born Persons in the United States, 1993–2016Self-Study Modules on Tuberculosis, 1-5 Slide SetsThe Tuberculosis (TB) in Correctional Settingsplus iconFacilitator GuideIntroduction to TB GenotypingEpidemiology of Tuberculosis in Correctional Facilities, United States, 1993-2017Prevention and Control of Tuberculosis in Correctional and Detention FacilitiesGuidelines for Preventing the Transmission of M. TB in Health care SettingsInvestigation of Contacts of Persons with Infectious TBEpidemiology of Pediatric Tuberculosis in the United StatesTargeted Tuberculosis Testing and Treatment of Latent Tuberculosis InfectionElectronic Tools & ResourcesWeb-Based Courses & Webinarsplus iconTB 101 for Health Care WorkersContent SyndicationInfographicsplus iconSocial Media GraphicsCustomizable Take on TB Infographic with InstructionsEventsWorld TB Dayplus iconU.S. TB ChampionsHistoryFeaturesplus iconTB Risk FactorsTreating Latent TB Infection with Short-Course RegimensWorld Tuberculosis (TB) Day 2021World Tuberculosis (TB) Day 2020Linksplus iconState TB Control OfficesAbout Usplus iconMission Statement and Activitiesplus iconDTBE Strategic PlanNational TB Program ObjectivesOrganization ChartAdvisory Groupsplus iconFederal TB Task Force To receive email updates about this page, enter your email address: Email Address			What's this?				Submit


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